January 6, 2010

"HIV costs much more to prevent and treat, the opponents of PEPFAR argue, compared with other deadly diseases. Therefore, they say, a larger share of the world’s health care funds ought to be spent on preventing and treating these other diseases, and less on HIV specifically. The underlying assumption is there will always be too few resources to meet global health care needs.

"In response, two Harvard University professors—Rochelle Walensky, MD, MPH, and Daniel Kuritzkes, MD—are making the case in the January 15 issue of Clinical Infectious Diseases (available now online) that programs such as PEPFAR have not only succeeded in their mission, but have also had benefits that go far beyond their original intent.

"PEPFAR, Walensky and Kurtizkes contend, has been an unqualified success in regards to its originally stated mission. By October 2008, they write, 10.1 million people worldwide were receiving HIV care, and 2.1 million were receiving HIV treatment. 'AIDS-related mortality in PEPFAR countries decreased by 10.5 percent relative to non-PEPFAR countries,' they state, 'a difference that translates into 1.2 million lives saved.'

"The pair also laud the impact of HIV-specific care and treatment on many other aspects of health in PEPFAR-funded countries, writing, 'Antiretroviral treatment and [PCP pneumonia medication] provided to HIV-infected adults in a Ugandan cohort was not only associated with a 95 percent decrease in mortality of infected adults, but also an 81 [percent] reduction in mortality of uninfected children and a 93 percent decrease in orphanhood.'"